Project Summary/Abstract Title: mm-Wave Imaging for use in Radiation Oncology Abstract: More than 500,000 cancer patients in the U.S. and several hundred thousand more around the world are treated with radiation every year; however, a small percent of these patients are treated with advanced non-coplanar radiation beam arrangements. This is a result of the inability to safely position and monitor patients for radiation delivery. New advanced radiotherapy techniques can reduce doses to critical organs by up to 72% and escalate dose to the tumor volume by >35% ? resulting in improved tumor response and control [3,5-9]. However, these advanced treatments involve simultaneous large non-coplanar motions of the patient support device and the linear accelerator ? leading to uncertainty in target localization. Current methods for imaging and monitoring a patient include x-ray, infrared, and optical systems which suffer from additional radiation dose, surrogate markers, and direct line-of-sight requirements [17-21, 42-44] ? mm-wave imaging is not subject to these limitations. Thus, the current systems restrict widespread adoption of advanced non-coplanar radiation delivery and the profound tumor control and organ sparing benefits that exist for patients. Preliminary data for mm-wave imaging collected in collaboration with Battelle-Pacific Northwest National Laboratory (PNNL) has shown that holographic imaging is a novel solution. A holographic mm-wave imaging system (similar to that deployed in airport body scanners) can image through patient immobilization devices with a high degree of accuracy while also providing a fast volumetric scan, zero additional imaging dose, and real-time distance to the patient surface without compromising immobilization devices. This system thus has the ability to enable >500,000 U.S. patients access to non-coplanar radiotherapy, reduce dose to critical organs and dose escalate tumor volumes ? while being independent of patient skin tone and improving patient safety. Further clinical benefits include the ability to localize and monitor patients in any treatment position while reducing patient treatment time and providing clinicians with novel daily volumetric image tracking tools to improve clinical efficacy. We will collaborate with PNNL to demonstrate that this novel imaging modality can volumetrically image a patient in real-time and obtain mm-wave scans on ten clinical patients. This proof-of-concept feasibility will be accomplished through a three-fold multi-disciplinary approach. Our partners at PNNL will perform simulations to determine optimal mm-wave electromagnetic characteristics for sub-millimeter feature resolution. The clinical physics team will perform motion and gating studies in a radiation environment to assess the clinical implementation and translation of this technology. Lastly, the physician team will perform image review and assess clinical patient benefit of volumetric mm-wave imaging. Translating this technology to patient care is expected to have similar lasting benefits to those realized in airport security but now with a focus on improving patient care. We expect the results of this R21 to attract an industrial partner with subsequent funding aimed at an Academic-Industrial Partnership R01 award.